| NPI | 1376291179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61266930) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0018797) |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-03-11 |